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Nigeria struggles with Ebola spread

By Sabrina TaverniseNew York Times

Posted:
08/10/2014 12:01:00 AM CDT

Updated:
08/10/2014 08:01:02 PM CDT

Ebola, one of the world's most fatal diseases, has surfaced in Africa's most populous country.

Nigerian health officials have announced 10 confirmed cases and two deaths from the Ebola outbreak that is sweeping West Africa -- including a nurse and a man from Liberia for whom the nurse had been caring.

The man, Patrick Sawyer, a naturalized U.S. citizen, had flown to Nigeria in late July and died soon after. He had infected at least seven other people, including the nurse, who died Tuesday, officials said.

By Friday, President Goodluck Jonathan had declared a state of emergency, officially adding Nigeria, home to more than 160 million people, to the list of nations struggling to control one of the largest public-health emergencies in recent history. More than 900 people have died.

The story of Sawyer, who according to Nigerian newspaper accounts was aware that he was sick when he left Liberia, demonstrates just how difficult containing the disease will be in the modern age of rapid travel and growing urbanization. Nigeria has Africa's largest economy and is deeply connected to the outside world, a fact that could magnify the consequences if the outbreak is not contained.

"Rapid epidemic transmission has been with us a long time, but my guess is that it's accelerating, with the number of people on the move and intensity of air travel, global trade and the numbers of displaced people we have globally," said Jeffrey Sachs, an economist and the director of the Earth Institute at Columbia University.

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Climate change, population growth and an increase in displaced populations means people are pushing into previously uninhabited places, creating new vulnerabilities and bringing humans into closer contact with animal populations, where many of the diseases have begun, he said.

At the same time, globalization means that people are mixing more, trading more and handling more farm animals in industrial settings -- all of which facilitate the emergence and spread of infectious diseases.

"This ought to force a reflection," Sachs said, adding that establishing a basic network of community health workers across the developing world is an urgent priority.

Health officials emphasized that Nigeria still had only a few confirmed Ebola cases and that its government had mobilized substantial forces to try to stop the spread of the disease.

David Daigle, a spokesman for the Centers for Disease Control and Prevention's effort in Nigeria, said the ministers of health and information were on hand Friday for the opening of an emergency operation center in Lagos, a sign the government was taking the situation seriously.

"The Nigerians understand the magnitude of the problem here," said Dr. Frank Mahoney, an epidemiologist who has been leading the CDC's Ebola response in Lagos.

Still, he said, international health officials are undertaking a substantial effort in Nigeria, motivated by what might happen if the disease, which had been confined to remote forests and villages in decades past, starts to spread in one of Africa's most densely populated countries.

"We are very worried about this," Mahoney said, pointing out that Nigeria's health care system could easily become overwhelmed. "Lagos is such a huge city with such a mobile population."

Lagos, a city of nearly 20 million, the most populous in Nigeria, is also home to a large contingent of religious healers, such as Temitope Balogun Joshua, a popular Christian minister and televangelist known as T.B. Joshua. Health experts are concerned sick people will flock to Lagos for his advice.

Mahoney said health experts were reaching out to such leaders, and Jonathan called on churches and religious leaders to halt large gatherings that could encourage the spread of the disease.

Almost all of the suspected Ebola cases involve people who had direct contact with Sawyer -- either in the airport where he was helped into a car or in the hospital where he was treated, the First Consultant Medical Center.

Newspapers in Liberia and Nigeria were brimming with accounts of the strange tale of Sawyer's sickness, which began in Liberia, where the disease is exploding.

According to a report in the National Chronicle, a Liberian newspaper, Sawyer's sister, who died of Ebola in early July, had arrived at a hospital bleeding. But when doctors and nurses tried to put her in isolation, the report said, Sawyer refused to allow it, demanding that she be given a private ward. He undressed her, put her into a wheelchair and offered the hospital workers cash, the paper said.

And in an account in another Liberian newspaper, The New Dawn, which cited footage from a security camera in the airport in Monrovia, Sawyer behaved strangely as he waited for his flight out of Liberia. He sat alone, avoiding physical contact with people -- including an immigration agent who tried to shake his hand -- and even lay flat on his stomach on the floor of a corridor of the airport, the paper reported.

The episode prompted the president of Liberia, Ellen Johnson Sirleaf, to publicly apologize to Nigeria about Sawyer, who she said had sneaked out of Liberia, where he was being tracked as a potential Ebola case, according to the Daily Independent, a Nigerian newspaper.

The number of suspected cases has continued to tick up slowly. Nigeria's state oil company announced Friday that it had closed its clinic in Lagos after a patient suspected of having Ebola was admitted there. The patient had visited the First Consultant Medical Center, which has since been closed.

In a strange twist, a doctors' strike in Nigeria may have saved lives by reducing the number of medical workers who came into contact with Sawyer.

"It would have been a disaster," said Babajide Saheed, a doctor and the secretary of the Lagos State chapter of the Nigerian Medical Association. "At the time, nobody was prepared for it."

About 70 people are believed to have had contact with Sawyer, Nigerian health officials said. Mahoney said teams of people were working to call those people and to try to persuade them to stay at home and watch for symptoms, such as a rising temperature.

Just as concerning was what would happen if the disease began to spread inside the health care system, Mahoney said.

"The health care system in Nigeria would have a really difficult time responding to a community wide outbreak," he said.